Diagnosing Septate Uterus Using Three-Dimensional Ultrasound Using Three Different Classifications: An Interobserver...

Area of Science:

• Reproductive Medicine
• Gynecological Endoscopy
• Medical Imaging

Background:

• Septate uterus diagnosis currently utilizes up to three distinct classification systems.
• Previous assessments of interobserver agreement among these classifications have been limited.

Purpose of the Study:

• To evaluate the interobserver agreement among nonexpert sonographers for septate uterus classification.
• To compare the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) systems.

Main Methods:

• Two nonexpert sonographers evaluated 50 three-dimensional (3D) ultrasound volumes of uteri.
• Measurements included indentation depth, angle, wall thickness, external indentation, and I:WT ratio.
• Diagnoses were assigned per the ESHRE/ESGE, ASRM, and CUME classifications; interobserver agreement was assessed using Cohen's kappa.

Main Results:

• Good interobserver agreement was found for ESHRE/ESGE (k=0.74).
• Very good interobserver agreement was observed for ASRM (k=0.95) and CUME (k=0.91) classifications.
• Agreement between ASRM and CUME was higher than between ESHRE/ESGE and ASRM or ESHRE/ESGE and CUME.

Conclusions:

• All three classifications (ESHRE/ESGE, ASRM, CUME) demonstrate good to very good interobserver agreement among nonexpert sonographers.
• The ASRM and CUME classifications show superior agreement compared to the ESHRE/ESGE classification.